Bharani Padmanabhan, M.D., Ph.D.
The cancer of accountable care has cut American lives short
The government dictates the profession of medicine in the United States. Over time the camel has fully taken over the tent, and “accountable care” and “patient care quality” means reaching a target set by the government. Not meeting these paper targets means that the government will reimburse the doctor less money for his or her work, and claim that the doctor is not good.
The practice of medicine now is the practice of maximizing reimbursement. Somehow a few patients are also helped along the way, though deaths of despair nationwide – intentionally misrepresented as drug overdoses – have climbed precipitously, and most indices of a people’s health have plummeted, including life expectancy. This fact is as notable as the collapse of Russia’s life expectancy rates under Yeltsin.1
Twenty years of “defragmented”“accountable care” has led to Americans dying sooner, 100,000 deaths of despair per year, and 20% of male recruits and 40% of female recruits being too heavy to enter the military, all of which harms the United States.
This of course was inevitable given that America’s doctors have abandoned their profession and became circus seals clapping for fish. The core of a doctor’s profession now is maximizing reimbursement, as explained below.
In 2022, the New England Journal of Medicine unexpectedly published an article on how mandatory compliance – “accountable care” – inevitably leads to fraud, as well as placing a useless burnout-causing regulatory burden on folks doing actual clinical work.2
Few realized it, but that Journal itself publishing this article is as extraordinary as the progressives themselves publishing Solzhenitsyn’s ‘One Day in the Life of Ivan Denisovich.’ It was a coup, and provided the impetus for writing this essay.
I immediately submitted a letter in response (knowing the Journal would not print it) which blamed Lucian Leape and Donald Berwick for the massive increase in compliance fraud: “Dear Editor, I commend Dr. Rosenbaum for writing about the lies that Berwick’s flawed system forces people to utter along with doing their real work. The flaw however is an original sin that vitiates everything. And that is intent. Both Berwick and Lucian Leape intentionally fabricated a system designed to make money for consultants by fabricating the medical equivalent of moral panic. … This QA [Quality Assurance] grift must be stopped and learned physicians must practice just medicine again.”
“Quality Assurance” has nothing to do with actual patient outcomes and is the enemy of the medical profession, American patients, and the United States. “Quality Assurance” = Increased
costs = Decreased life expectancy. And yes, a “peer-reviewed medical journal” actually published the Leape grifters’ claim that doctors kill 400,000 Americans year on year.3
This same cancer led to the Volkswagen Dieselgate scandal in Europe. The government dictated that diesel is preferred and provided a subsidy at the pump. The European public immediately clamored for diesel cars because that would please the government and save them some money at the pump.
Not one European questioned why the government subsidized a more-polluting fuel. VW engineers knew there was no way they could produce more diesel cars and still meet environmental emissions targets for particulates.
But appeasing the government became an overwhelming force, as it does when money incentives are involved, and VW caved. It made more diesel cars but installed a computer algorithm in them that cheated on emissions tests, thereby maximizing reimbursement from the government, and everyone was happy, except a bunch of engineers in West Virginia who eventually exposed the fraud.
Dieselgate would not have happened without government’s incentive policy and the people falling over themselves to comply, even when they know compliance requires fraud. Not one person publicly complained that the incentive scheme required fraud on the pollution side.
The cancer of maximizing reimbursement has also massively damaged America’s formerly- innovative pharmaceutical sector. Choices during drug discovery are now made not with an eye towards the best candidate drug in terms of curing disease, but whether it can be infused monthly, thereby maximizing reimbursement. This is because the government dictates higher payments for IV infusions compared to mere tablets. The drug delivery system is more important now than an actual cure, because an open-ended subscription reassures stock analysts.
Only one pharma company openly and honestly discussed the fact that maximizing reimbursement drives all decisions. In 2013, Gilead priced its drug Sovaldi (sofosbuvir) at
$84,000 per treatment, because it cured a hitherto incurable infection that resulted in a liver transplant and cancer. Because Sovaldi cured the disease outright, meaning it would not be an open-ended monthly subscription, Gilead felt justified in demanding money up front, meaning Sovaldi follows the standard ‘maximizing reimbursement’ model but with accelerated payments. It remains to Gilead’s credit, however, that it released an actual cure. Naturally, few physicians prescribe it.
Imagine, back in the day before Henri Termeer and the Kendall Square Model took over, pharma companies used to intend their new drugs to cure diseases outright.
So how did we get here? It began with demonizing American physicians, a learned community of generally bookish, soft, squishy types with a culture of helping others.4
Jury consultants know well that the people who select medicine as a profession are dramatically different from the standard jury composed of a standard cross-section of society. This selection bias results in physicians being people with an innate desire to help others. And they got treated as the enemy.
First we slowly reduced payments for physicians to below actual cost, which left most physicians struggling to balance the books. They began fighting for scraps to survive, began to engage in unethical behavior as Zimbardo and Abu Ghraib showed, then began doing non-clinical paying work such as legal consultancy, stock analysis, and hospital management. Patients began waiting months for an appointment with clinicians. Physician pay was cut 2% in 2023 and will be cut another 3.5% in 2024 in the face of 17% inflation. It has fallen 20% in real terms.5
Then we demonized physicians for accepting free plastic pens from pharma companies and for having a couple of slices of pizza for lunch brought in by a drug rep. If physicians were paid what they deserved, they wouldn’t have noticed free pens and pizzas. This demonization began with Lucian Leape’s acolytes.
Then we allowed Lucian Leape to peddle the blatant lie that physicians kill 100,000 Americans year after year through “medical error.” This number later jumped to 250,000, then to 400,000.
Leape’s original paper in the New England Journal of Medicine, a typically sloppy retrospective chart review, extrapolated from a tiny data set to claim that New York physicians are associated with 48000 – 96000 adverse events a year.6 If you tripped on the rug in the lobby as you left the hospital after an inpatient stay, it was an adverse event.
Leape coolly changed this to 96,000 deaths when he wrote a report for a small private NGO that intentionally called itself the Institute of Medicine in order to bamboozle suckers into assuming it was associated with the National Institutes of Health.7 This mere private NGO’s report – ‘To Err Is Human’ – explicitly recommended that hospitals hire a private firm called The Leapfrog Group, in order to reduce said medical errors. The New England Journal promoted it to the hilt.
The Leapfrog Group issues a Safety Score to hospitals in all markets within the United States every year. If you purchased a defined data-set from Leapfrog, it granted you the top score of A. If you refused to purchase data from Leapfrog, like Kuakini Medical Center and Yale Hospital bravely did ten years ago, the highest score you could receive was a C.
Leapfrog loudly proclaims its Scores in the press in all markets. This creates enormous pressure on hospital executives who refuse to pay money to Leapfrog for an A and thus lose out to competitors who did pay and got an A, which they then tout on billboards.
When honest physicians and hospital executives (yes, a handful exist) pushed back, Leape published a paper that baldly asserted that the Leapfrog Safety Score is valid and not just an
extortionate fraud. This paper was published in the Journal of Patient Safety by editor Charles Denham. Denham was also officially associated with Leapfrog, along with Leape, Berwick, and Ashish Jha. Naturally, no one disclosed that.8
Denham is who accepted $11 million from CareFusion to install its 2% chlorhexidine hand sanitizer as the national standard for skin cleaners. Only CareFusion made 2% chlorhexidine, while all the others made 1% chlorhexidine.9 Denham paid $1 million to settle the kickback charge.10
When Donald Berwick was the Medicare Administrator, he officially recommended, on USG letterhead, that all hospitals “cooperate” with Leapfrog and obtain a Leapfrog Safety Score every year.11
In 2014, I published a column wondering how many millions Berwick received for shilling for Leapfrog on USG letterhead while Medicare Administrator.12
If only the HHS Inspector General was not focussed on Hispanic businesses in Florida, this Yankee grift would have been prosecuted. If Berwick’s last name were instead Bernardo, OIG would have put him in prison already. No small Hispanic business is responsible for the steep drop in life expectancy in the United States.
The National Patient Safety Foundation, founded by Leape, created the Lucian Leape Institute to honor Leape – the Father of Patient Safety, and began pushing for compliance paperwork that grifters could then audit, for a price. Naturally, the Leape Institute merged with Berwick’s own Institute for Healthcare Improvement. Numerous Leape acolytes occupy positions within the New England Journal community and routinely publish articles in support of his brazen unscientific fraud.
Leape testified before numerous legislative bodies strongly urging the adoption of centralized electronic medical record databases in order to provide “accountable care,” but intentionally concealed the inevitable consequent need for massive consolidation of hospital systems within a market as a direct result of requiring centralized “accountable care.”
Judy Faulkner has announced that her Epic electronic record system, which has moved from hospitals to the cloud, will now go national. “We’ll get an overview of the places of care that have data or need data about the patient. We are building a nationwide health IT infrastructure to connect the different parts of health care.”13 Over three-quarters of Americans have a clinical record in the Epic system. Ma Bell is reincarnated.
Centralized = antitrust violation = harm to the United States = un-American.
Leape provided the false medical veneer to justify massive market consolidation, and his efforts culminated in government rules that financially punish physicians who maintain independent practice.
As a direct result of this concerted campaign by Leape, Berwick and their acolytes through the New England Journal (read and cringe14), within just ten years the majority of American physicians are now merely salaried employees of hospital systems with dominant market power and that are not controlled by physicians.
Leape is personally responsible for pushing the destructive label of “disruptive physician behavior” in order to destroy all physicians who stood in the way of the takeover of hospitals by private equity funds and consolidation within the medical marketplace.
Enforcing Leape’s push towards state capitalism is the official policy of the government of Massachusetts, which set up the Betsy Lehman Center to carry out Leape’s goals. The Massachusetts medical board has destroyed many good physicians on behalf of corporate hospital systems, through the false claim of disruptive behavior, in the absence of patient harm. Berwick’s direct student, Julian Robinson, is the current chair of the medical board.
The Massachusetts board fought Dr. Sheldon Schwartz in the state supreme court after it indefinitely suspended his license on behalf of corporate behemoth Universal Health Services, Inc. (annual revenue $12.6 billion). UHS’ corporate attorney herself ran the board investigation and hearing, and it’s impossible to tell where the corporation ended and the board began.
The board is on record to the Massachusetts supreme court that the hospital CEO is a member of the medical care team and thus any argument from a physician to a CEO regarding putting profits above patients shall result in indefinite license suspension due to disruptive behavior. One supreme court justice, former corporate attorney Delilah Wendlandt, ruled that is perfectly okay!
The full court declared that it did not want public oral argument in Dr. Schwartz’s case so the court’s strong support for state capitalism remains concealed, and promptly affirmed Wendlandt’s bizarre ruling because it fully supports corporate capture of medical boards.15
We all know at least one doctor destroyed by a state medical board where we can’t fathom why. That’s because most of us suffer under the delusion that boards act on behalf of the public to protect public safety. Applying the correct filter easily lets one understand that the doctor was ‘taken out’ by the board on behalf of his or her competitors. A state medical board is an economic hit man. Years ago I published a column on this.16
The only solution is to have two independent medical boards per state with no antitrust immunity. This shall ensure that public safety is maintained while blocking corruption by competitors. Only this shall end the ongoing harm to the United States by the strangling of competition in the medical marketplace through regulatory capture.
Leape and Berwick achieved their final victory when the government banned physician-owned
hospitals. Only hedge funds and corporations may own and run hospitals now. After all, who better to own and run hospitals than private equity hedge funds, eh? Leape and the New England Journal have successfully transformed medicine from a local small-business free market into state capitalism.
Those of us who were around in 1985, personally remember what happened when Pepsi Cola’s CEO John Sculley took over as Apple Computer’s CEO. By 1996, Apple was where American medicine is today. Sculley has since moved on to ‘healthcare.’17
The damage from private NGO, Public Citizen, and the Boston Globe has been incalculable. Both serve to intentionally misdirect attention away from the takeover of medicine by private equity.
On September 9, 2022, the Globe and Public Citizen, in a story titled – “Doctors tried to stop surgeon from operating. Hospital leaders resisted.” – reported on a retired surgeon who harmed people for years but was protected by corporate executives because he was a rainmaker. As expected, the Globe and Public Citizen have no problem with the fact that doctors are not the hospital’s “leaders” and instead claimed that state medical boards don’t suspend enough medical licenses.
Just as private equity took control of public pension funds and bled them dry while making the “managers” new billionaires, the same types have now been gifted the profession of medicine by Leape and Berwick.18 19 20
Leape, Berwick and the New England Journal spent 15 years talking down physicians and talking up airline pilots. This was intentional. Airline pilots are union labor. Hitherto physicians are not. The intentional push to turn independent physicians into union labor working as mere employees of hedge fund-owned hospital systems with consolidated market power, cannot be unseen.
The push to hold up airline industry practices as the example for physicians to follow, is harmful. Patients are not mass-manufactured machines with known characteristics.21 Already back in 1994, the crash of US427 (N513AU) exposed the disastrous fallacy underlying this push.
In 2019, the Boeing 737 MAX tragedy again revealed that airline pilots are vocational workers rather than independent professionals. And this was in a situation where the manufacturer knew everything about the machine, and the machine was the same at both Lion Air and Ethiopian.
Physicians, in contrast, deal with 15-30 totally different human beings every single day. Then again, Leape, Berwick and the New England Journal don’t care.
In addition, the government changed the law to require that all physicians must register with Medicaid if they wish to even hold a medical license in any state. This brought all physicians and their medical notes under the jurisdiction of the government for the first time in US history. No
longer is a court order needed to read anyone’s chart. If the government wants to come after you, like it went after Dan Ellsberg, all it needs to do now is threaten your doctor’s license and voila! your medical records will be theirs.
If you scientifically follow the data and actual results on the ground, twenty years of believing Leape, Berwick and the New England Journal has resulted in a historic decline in life expectancy in the United States, massive increase in obesity rates, 100,000 annual deaths of despair, loss of control by physicians over their own profession, massive consolidation of market power by non- physician hospitals, and massive increase in the amount of money stolen from patients through increased fees – none of which flows to the physician employees.22
If you claim that you follow “evidence-based medicine” and that you aren’t simply a sucker dazzled by the New England Journal brand, this is the evidence of the massive devastation wrought by Leape, “Quality Assurance,” “defragmentation” and “accountable care.” The data is undeniable and damning. “Accountable care” is worse than even littoral combat ships.23
The other huge problem is one of identity. The United States now has lots more people who recently moved here from countries like the People’s Republic of China and the Socialist British Commonwealth of India, where the dominant culture is not assertive individual independence in the face of government dictates. Citizens from these countries are far more likely to personally agree that following government orders is desirable, and “harmonious” compliance is how it’s supposed to be done. (The United States was founded as an alternative to that approach.)
In those countries, physicians who remain true to their profession are targeted for public destruction. This was demonstrated openly in the case of Dr. Li Wenliang, who was forced by PRC police to apologize for “spreading false rumors” about a new variant of Severe Acute Respiratory Syndrome and to promise to not do it again. He apologized and promised.24
One of the most public examples in the US is that of immigrant Russian psychiatrist Dr. Isak Isakov who refused to discharge, from his Jamaica Hospital locked ward, NYPD whistleblower Adrian Schoolcraft, unless he received permission from the police. Cringe! NYPD had kidnapped Schoolcraft from his home in retaliation for exposing NYPD’s practice of refusing to file victim complaints in order to make its major crimes stats look lower, a classic case of metrics fraud.25
The Socialist British Commonwealth of India, officially also known as the ‘Union of India,’ is a country that to this day enforces British laws from 1878; that was the first to ban Salman Rushdie’s book, which ban continues to this day; that routinely arrests and prosecutes citizens for tweets, Facebook posts, YouTube videos and editorial cartoons that report corruption or promote dharma26 27; that demands online platforms bow to it without itself innovating a single platform or service used worldwide, not WhatsApp, not Google, not Zoom, nothing; that (like Cuba and North Korea) bans the use of satellite phones ‘under the provisions of the Telegraph Act of 1885’ even though India never invented anything related to that technology28; and that unashamedly violates its own citizens’ rights because respecting them “would seriously impair the conduct of foreign affairs of the Government of India.”
The very first amendment to India’s new Constitution (as yet unratified by the citizens) by the progressive Nehru was one explicitly aimed at censoring speech29 : “Nothing in sub-clause (a) of clause (1) shall affect the operation of any existing law, or prevent the State from making any law, in so far as such law imposes reasonable restrictions on the exercise of the right conferred by the said sub-clause in the interests of the security of the State, friendly relations with foreign States, public order, decency or morality, or in relation to contempt of court, defamation or incitement to an offence.”
When physicians from the Socialist British Commonwealth of India become the managerial executives within American hospitals, it is inevitable that maximizing reimbursement through apparent compliance with government directives becomes the sole paradigm. How could it be otherwise? They don’t know of any other approach or attitude. In the Socialist British Commonwealth of India, clapping for fish is the norm.
When persons graduate from school with high grades because they gave the government the answers it insists are correct, then went through various degree mills that prepared them solely for maximizing their exam scores, they are not going to even value disruptive innovation, let alone bring it about, and certainly are not the people who would stand up for American patients against the government or private equity.
The American concept of individual enterprise that may be at odds with government policy but is legitimate nonetheless, is alien to them. The concept that the government may not dictate how physicians treat their patients, is alien to them. Naturally, Indian-origin physicians are Leape’s true believers. The Leape Institute was established and run by a physician of Indian origin. How could it be otherwise?
Dr. Sheldon Schwartz’s license was suspended on behalf of corporate behemoth UHS Inc. by Massachusetts medical board chair Dr. George Abraham, the Indian-origin President of the American College of Physicians. How could it be otherwise?
The impact of the Socialist British Commonwealth of India’s values on previously pro-1st amendment Twitter, in the form of Vijaya Gadde and Parag Agrawal, has been devastating. How could it be otherwise? Elon Musk’s very first action upon purchasing Twitter was firing them.
The Federation of State Medical Boards has been led for years by Dr. Humayun Choudhry, a physician born in the British Commonwealth country of Pakistan, and so, of course, supports measures to revoke the medical licenses of American physicians based on their speech alone. How could it be otherwise?
Dr. Choudhry’s approach met its first success in California when Governor Newsom signed AB2098 into law, which allows medical licenses to be revoked when the physician’s speech is contrary to “contemporary scientific consensus,” you know, like Galileo.30 The Old World is finally bringing the New World to heel.31 32 Surgeon General Vivek Murthy is doing his bit too.
FSMB Director Choudhry’s book was also cited by the dissenting justice who opposed the Supreme Court’s majority ruling in North Carolina Board of Dental Examiners v. Federal Trade Commission, 574 U.S. 494 (2015), meaning he opposed this: “Federal antitrust law is a central safeguard for the Nation’s free market structures. In this regard it is “as important to the preservation of economic freedom and our free-enterprise system as the Bill of Rights is to the protection of our fundamental personal freedoms.” How could it be otherwise?
There is a grave danger to the medical profession itself from doctors defined by compliance fraud. New Jersey got its claws into Indian-origin Dr. Manoj Patharkar for financial kickbacks and then revoked his medical license for prescribing drugs off-label, meaning outside the government’s official indication. This is a terribly dangerous development. Naturally, Dr.
Patharkar pleaded guilty and helped the government set legal precedent on that point. How could it be otherwise?
Katherine Eban published a detailed book, Bottle of Lies, which laid bare the entrenched Indian culture of compliance fraud when they manufacture millions of generic pills that are dispensed to American patients every day. There was an alarming difference between findings made in unannounced FDA inspections and findings made after six weeks notice of an FDA inspection.
Six weeks notice of FDA inspections harms the United States.
Again in 2023, the FDA was forced to warn “consumers not to purchase or use certain eye drops from several major brands due to risk of eye infection” because the drops were made in unsanitary Indian factories and their safety officials admitted to compliance fraud.
Because base rates for physicians remain below actual cost, cheaper immigrant physician-executives dominate hospitals that are most dependent on government reimbursement, such as the VA system and public hospitals, and which commit fraud inevitably on a daily basis to maximize reimbursement.
The MRI fraud at the Jackson VA Medical Center in Mississippi is a classic example which exposed “the unprofessional practice of Majid Khan, a radiologist who admitted that he did not look at all images of every radiologic study for which he gave interpretations. Even Dr. Khan’s immediate supervisor and co-defendant, Dr. Vipin Patel, admitted under oath that Dr. Khan’s conduct constituted “intentional medical negligence.” The motivation for this unprofessional conduct was money.”33 34
Individual physicians with older American values and mores are deemed ‘disruptive’ and fired for not maximizing reimbursement, and instead taking charge of their own profession by actually providing sick patients with needed care. If you are not committed solely to maximizing reimbursement, you are not a team player and must be exiled. You are welcome only if you view the practice of medicine as clapping for fish.
As it is, Nobel laureate Dr. Thomas C. Südhof has clearly identified the problem with scientific publishing: “The sociology of science is set up so that people do research that will get published, and that will get grants.” Meaning people shy away from areas that the NIH overlords have decided don’t deserve government funding, like non-amyloid Alzheimer’s research.35 Alzheimer’s researchers have been exclusively clapping for fish for twenty years, and we have nothing to show for the money, other than fancy cottages on Cape Cod.
Biogen is the poster child for a good science-based company that became a loser clapping for fish. It corruptly collaborated with the amyloid cabal within the FDA to get aducanumab approved based solely on reduced beta-amyloid levels, which we all know means nothing in real life. Biogen then priced its new drug at $58,000 per year, explicitly maximizing reimbursement. Biogen = clapping for fish = maximizing reimbursement.
That the FDA corruptly approved Biogen’s aducanumab though it is clinically useless is proved by the need to physically destroy the capillary Blood Brain Barrier in order to force aducanumab into the brain, as done by Dr. Rezai.36 This intentional destruction of the BBB through focussed ultrasound violates the mandatory respect for evolution, exactly like force-feeding cows to other cows, which resulted in Variant Creutzfeldt Jakob Disease in humans.37 And the sole reason to do it is to give Biogen an excuse to sell aducanumab, and allow the institutionally-corrupt FDA to claim its approval was scientific, and not simply purchased.
Naturally, the New England Journal lauded this unscientific, anti-evolution, abomination in support of a major Massachusetts corporation. How could it be otherwise? Biogen’s website lists a steady stream of press releases with titles that begin with “New England Journal of Medicine Publishes….” Biogen’s result is believable because the New England Journal published it. Get it? Hand, meet glove. This is Boston. Nothing better may ever be expected.
In 2008, Judith Warner wrote a remarkable column in the New York Times titled ‘Waiting for Schadenfreude’ – “A couple of years ago, at the height of the boom, a friend in New York publishing described to me the indignities of being a five-figure employee commuting daily from suburban New Jersey on trains packed with traders, stock brokers and hedge-fund types. “These were the guys who, in college, I used to step over on Sunday mornings when they were lying in a pool of their own vomit,” he said. “And now they’re earning millions and millions – in bonuses alone.” The feeling of injustice wasn’t just about money…It was, rather, about a sense that the wrong people had inherited the earth. Schadenfreude is impossible because the fat cats … are taking us down with them. The language of Wall Street — of cost-cutting and efficiency, self- interest, using each situation to maximize profit, is the language of everyday life and social interaction. We’re all losers now. There’s no pleasure to it.”
The wrong people have captured the profession of medicine and are taking us down with them. Losers best describes doctors clapping for fish. And yes, there’s no pleasure to it.
Harvard Business School’s Indian-origin dean just announced that his school will provide free MBA degrees to lower-income students, cuz, you know, what the United States needs right now is more people with MBAs.
Just as Blackstone’s Stephen Schwartzman used a retired public pension manager from progressive Oregon, James Chris George, to inveigle pension funds into handing their billions over to him, these new MBAs will be used to fool lower income communities worldwide through personal testimonials: I come from where you are, I am one of you, You too can become me!
What’s a good name for this tactic? Oh yes, affinity fraud.
Matt Stoller, research director at American Economic Liberties Project, lists examples of this affinity fraud: “Richard Gephardt, the onetime House Democratic leader who had been an ally of unions, used that credibility extensively to make private equity seem reasonable. David Marchick, a Clinton administration appointee, worked at The Carlyle Group, a Washington-based private equity giant, and set about persuading unions that their pension savings would do well in the hands of leveraged buyout firms.”
Affinity fraud is the perfect description for Berwick’s and Leape’s actions the past thirty years. Berwick = Leape = New England Journal of Medicine = affinity fraud.
Their actions were intentional. The result is massive market consolidation, siphoning of billions out of patient care, destruction of the independent profession of medicine, and an historic drop in American life expectancy. Americans are dying sooner because of these three.
Yes, prior to twenty years of “defragmentation” and “accountable care,” Americans lived longer. Leape, Berwick and the New England Journal have actively harmed the United States.
The tragedy is that we now have turned an entire generation of America’s doctors into compliant appeasers who think the profession of medicine is meeting the government’s targets and maximizing reimbursement, exactly like the engineers and executives at Volkswagen.
In countless clinics all across the United States every single day, millions of Americans are being neglected because the doctor will deal with only one problem per visit, meaning when an obese diabetic man comes in for high blood pressure, the doctor simply ignores the fact that the patient’s HgA1c level has not been tested in a year. Why? Because the doctor gets reimbursed for only one problem per visit.
This intentional bureaucratic neglect has resulted in increasing cancer incidence in people below 55 years of age, exactly as one would expect from the time frame.38
No real physician would have concocted that rule. Only a bureaucrat would find it acceptable. And the profession has degraded so much, doctors don’t say, you know what, the patient is here, I must test his HgA1c to see how his sugars are doing even if the government won’t pay me.
There is a rare analogy from the world of airline pilots (since now physicians are expected to be just like airline pilots). On May 12, 1982, Braniff Airways shut down while Flight 501 was still in the air between Dallas and Honolulu. The Captain made the decision to continue the flight, rather than divert to Los Angeles, because the passengers had paid their fares and deserved to arrive in Honolulu, even though the pilots and crew would be working for free. And Flight 502, the return flight from Honolulu, also took passengers back to Dallas, with the pilots again working for free but demonstrating their commitment to their passengers. This event is so rare that it is fondly remembered to this day.
More than ten years ago, while working at Cambridge Health Alliance, where Leape was a major Trustee, I complained that I was blocked by their Epic medical record system from giving my patient the correct diagnosis of Charles Bonnet Syndrome, because back then there was no billing code associated with that diagnosis. Only billing codes mattered in Leape’s hospital.
Leape’s hospital also pioneered firing diabetic patients who missed their eye exams because they made annual scores drop, and issuing brain MRI reports without even viewing the images.
Compliance fraud regarding brain scans or mammograms kills patients. Compliance fraud regarding x-rays of aircraft fatigue fractures kills passengers.39
Leape’s Cambridge Health Alliance, a small public hospital system, cost Medicare and Medicaid
$400 more per patient per year than did Massachusetts General Hospital. Leape’s hospital is the epitome of compliance fraud.
Either you are an independent medical professional, or you are not. Pick one. And if you choose to not be an independent professional, resign your medical license. Private equity is anyway packing hospitals with physician-assistants and nurse-practitioners, who have never been independent professionals who stood up to administrators and private equity.
The hedge funds and corporations prepared for that day by first erasing the term physician and replacing it with provider. To quote Yeonmi Park: control the language, control the thoughts, control the masses.
Every single person who warns you that using physician instead of provider makes colleagues feel unsafe, is a person shilling for private equity.
In addition to complying with the government’s documentation and treatment dictates and maximizing reimbursement, America’s doctors complied fully also with the government’s dictate to cause tremendous suffering to patients with chronic pain, and ended up killing more pain patients.40
Throwing pain patients out on the street to appease the government only caused the number of deaths of despair to double, yes, from 50,000 a year to 100,000 a year. The meek compliance of America’s doctors has undeniably proved deadly to an extra 50,000 Americans, every year.
We built a memorial in Washington to the 58,000 Americans killed in the war in Viet Nam. Here 100,000 Americans have died, in one year, because doctors in the US abandoned chronic pain patients on government orders, exactly like doctors in Russia.
That is the same as 100,000 Americans who did not return home from a war. Where are the memorials? When will we read out their names on television?
Why did we allow a private group, Andrew Kolodny’s ‘Physicians for a Responsible Opioid Policy,’ to set government pain policy and kill an extra 50,000 despairing Americans? That’s more deaths than the Tokyo Sarin attack. Why is Andrew Kolodny not in prison?
Why did American physicians instinctively support the new prohibition? Why are American physicians perfectly OK with the government claiming that diacetylmorphine (Heroin®), the prodrug for morphine (Kadian®), has no medical purpose? As if, you know, omeprazole (Prilosec®) has a medical purpose, but its prodrug esomeprazole (Nexium®) has no medical purpose. Who is the government?
The sole utility of the Controlled Substance Act is to generate windfall profits for criminal cartels, exactly as alcohol prohibition created organized crime.
It will take the profession many generations to recover, even if it abandons existing harmful practices immediately.
The first step is for all physicians to immediately renew their membership of the American Medical Association. Thus far the AMA has been happy to not have most American physicians as its members because it is content to receive significant royalties from the use by the government and private insurers of its billing codes and not deal with member demands. It is time physicians reappear on the AMA’s radar and reassert the profession’s control over its major association.
Without physicians retaking the AMA, American medicine is doomed, and eventually the rest of the planet as well.
If we allow any more non-disruptive, compliant, salaryman cowards in medicine, we all will die.
Physicians who care about chronic pain patients did just that over the past two years, led by Dr. Chad Kollas et al, and ensured a public declaration from the AMA that pain patients deserve pain relief. This was a major pushback against the government narrative.
The AMA also supported pain physician Dr. Ruan at the US Supreme Court which resulted in a devastating defeat for government bureaucrats who hitherto decided by themselves which medical prescription was legitimate and which not. The AAPS filed an amicus brief in Dr. Ruan’s support.
Let the success of Ruan v. United States, 597 U.S. (2022) inspire physicians from all fields to retake control of the AMA, and their own profession, from hedge funds, corporations, the government, and the New England Journal. All physicians must be one, with no division by field of interest. We must actively guard against all efforts to divide and rule.
This shall reduce the massive ongoing harm to the profession, to patients, to the free market, to innovation, to drug discovery, and to the United States.
Dedicated to the memory of Malchiel Grünwald.
Dr. Bharani is an Indian-origin neurologist trained in neuroimmunology. He lives in Brookline, Massachusetts. scleroplex@gmail.com
Citations:
1 https://pubmed.ncbi.nlm.nih.gov/9508159/
2 https://www.nejm.org/doi/full/10.1056/NEJMms2200976
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